5193 N.E. Elam Young Parkway, Suite A  Hillsboro, OR 97124-6680
503-726-2159  www.hsfonline.org
Derby: The Stakes are High Gala and Auction
February 20, 2016
Donation Form
Item:
(written as will be on bidder sheet and in marketing. ie: gold & emerald necklace by Kathy Huntington)
Item Description (Please include details and any restrictions to help us prepare catalog and bid
sheets.)
________________________________________________________________________________
________________________________________________________________________________
____________________
Expiration date?
Certificate: None
When?
Included with form
Current item location: Received
Donor will send
Donor will deliver
Software to generate
Arrange pick up
Value of Item: $
Donor Information
Donor has previously donated (Complete Donor name only):
Donor is new or information has changed (Complete fields with new information)
Donor’s Name:
Individual Donor
Business Donor *Include contact person for business
*Contact Person: _________________________________ Phone:
Address:
City, State, Zip Code:
Phone:
Email:
_______________
Website:
Solicitor:
Thank you so very much! Please complete fully and return to: 5193 NE Elam Young Pkwy #A Hillsboro OR
97124
501 (c)(3) Federal Non-Profit Tax ID Number 91-1779425